Safe Staffing Advice from NICE Concerning Midwives

NICE Guidelines

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The National Institute for Health and Care Excellence (NICE) has provided advice on safe midwifery staffing levels. This guidance was commissioned by the Department of Health and NHS England in November 2013 and is part of a series of guidelines which NICE will develop on safe staffing in the NHS. The safe staffing levels have a specific focus on nursing and midwifery.

The latest recommendations from NICE sets out responsibilities for organisations to consider as part of their midwifery staff plan. The NICE guidelines also set out how midwives on a shift should monitor the staff compliment to ensure sufficient resources to provide safe care. Cathy Warwick, chief executive officer of the Royal College of Midwives, has welcomed the guidance which she says should “help to ensure that maternity services have safe staffing levels that are monitored on a regular basis”. On the political front, the Labour Party has pledged to provide one midwife per mother and baby. The guidelines have been issued to ensure safe levels of care for mothers and babies 24/7. In its detailed guidance, NICE provides step-by-step instructions for organisations to work out the number of midwives required, including making sure that local records are used to help predict requirements and any potential variations in demand.

The NICE committee making the recommendations stated

giving birth can be associated with serious safety issues and in order to ensure that a woman has a safe experience of giving birth, the guideline recommends that women in established labour should receive supportive one-to-one care.”


Greater Planning Responsibility for Senior Midwives

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Within the guidelines there are recommendations for contingency plans to respond to the unexpected, such as babies demanding to be born earlier or insisting on staying safely within mum. Nursing-Matters note the comprehensive nature of the guidance issued by NICE which takes into consideration sourcing extra staff, redistributing midwives’ workload to other staff or rescheduling non-urgent work.

For senior midwives, the guideline recommends working closely with managers and regularly monitoring positive and negative events to collate data on the adequacy of staffing levels. This can, to some extent be achieved by utilising the data already routinely collected in hospitals such as staff overtime and missed breaks by staff. Senior midwives would be expected to be integrally involved in staff planning and effective resource management to cater for unexpected events. The Royal College of Nursing (RCN) Chief executive Dr Peter Carter said “Senior midwives are ideally placed to monitor staffing needs to provide safe care.”

The NICE guidance also highlights warning signs for patients and hospital staff to identify when there may be too few midwives on hand. These ‘midwifery red flag events’ can include events such as; a woman waits more than an hour for stitches or to be washed after giving birth, or is not provided with the medicines she needs following admission. Red flag events should be notified to the midwife in charge to determine whether any action is needed.


Project Cost?

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So that is the projected cost going to be? NICE has produced a separate report which looks at the potential impact that implementing the guideline may have on NHS resources. Precise estimates of the cost of the guideline nationally are very difficult to produce because safe staffing practices are already being made and because it is difficult to estimate the current cost of midwife staffing across the country. The reported costs vary from being additional spends to actually being a cost saving in the long term. The report estimates an additional cost of £4m could be incurred to implement the one-to-one ratio however, if all current vacant midwife posts are filled this could well be less or even zero. A study published by the Lancet  states that this will actually be a saving, stating “the study, which looked at the births of over 1700 women at 2 teaching hospitals, found that one-to-one midwifery cost roughly £333 less per woman and had similar outcomes for women of any risk, with better outcomes in some areas”.


Additional Midwives

More Midwives - Nursing Matters

How many additional midwifes will be needed? The Royal College of Midwives, calculates that 3,000 more midwives are needed although the figure has been mooted to be as high as 5000. If you are interesting in supporting the call for more midwives you can sign the ePetition here.

The Complete NICE Guidance